www.medscape.com Abstract and Introduction Abstract Learning Objectives The recent update to the Surviving Sepsis Campaign Guidelines advocates for the use of routine sepsis screening. We have previously shown that sepsis screening improves outcomes in surgical patients but data are lacking in the trauma population. The purpose of this prospective, observational study was to determine the utility of a novel screening tool for the early identification of sepsis in trauma patients. Methods Patients admitted to the trauma service were screened for sepsis twice daily using our sepsis screening tool which assesses a patient's white blood cell count, respiratory rate, temperature, and heart rate and assigns a numeric score (0 to 4) for each. Patients with a score of ≥4 screened positive. ACCP/SCCM Consensus definitions were used to diagnose sepsis. Sensitivity and specificity were calculated using a standard two by two table. Chi square analysis was used for categorical data. Values are expressed as mean ± standard deviation. Results 10,201 screens were completed on 1,637 trauma patients admitted to a Level 1 Trauma Center. The incidence of sepsis was 7.3%. The sepsis screening tool had a sensitivity of 92.5%, specificity of 97.4%, positive predictive value of 73.5% and negative predictive value of 99.4%. There was no difference in the age (43.3±18.15 vs. 42.7±19.1, p= 0.74) or gender (74.1% male vs. 68.7% male, p=0.22) of patients with sepsis and without sepsis. Patients that developed sepsis had higher injury severity scores (23.3±12.3 vs.12.7±9.3, p<0.0001), increased hospital length of stay (31.1±26.7 vs. 8.5±8.4, p <0.0001), increased intensive care unit (ICU) length of stay (16.4±16.3 vs. 1.7±3.9, p<0.0001), and fewer ICU free days (14.7±19.4 vs. 6.9±7.1, p <0.0001). Thirty-day ICU mortality decreased from 13% to 8% (p=0.08) after implementing the sepsis screening tool. Conclusions Sepsis in trauma patients has a significant impact on patient outcomes. Our sepsis screening tool accurately identifies sepsis in trauma patients with a high sensitivity and specificity. The implementation of routine screening was associated with improved ICU mortality rates. Crit Care Med. 2014;42(12) © 2014 Lippincott Williams & Wilkins Simple, Reliable Sepsis Screening Tool Improves Mortality in Trauma Patients Laura Moore, Rosemary Kozar, Jeff Brekke, Joseph Love, Michelle McNutt, Bryan Cotton, Rondel Albarado, John Holcomb Crit Care Med. 2014;42(12) http://www.medscape.com/viewarticle/836238_print 1 of 1 2/6/2015 8:22 PM

Simple, Sepsis Scrning Tool Imprves Mortlity

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Page 1: Simple, Sepsis Scrning Tool Imprves Mortlity

www.medscape.com

Abstract and Introduction

Abstract

Learning Objectives The recent update to the Surviving Sepsis Campaign Guidelines advocates for the use of routine sepsis screening. We have previously shown

that sepsis screening improves outcomes in surgical patients but data are lacking in the trauma population. The purpose of this prospective, observational study was to

determine the utility of a novel screening tool for the early identification of sepsis in trauma patients.

Methods Patients admitted to the trauma service were screened for sepsis twice daily using our sepsis screening tool which assesses a patient's white blood cell count,

respiratory rate, temperature, and heart rate and assigns a numeric score (0 to 4) for each. Patients with a score of ≥4 screened positive. ACCP/SCCM Consensus

definitions were used to diagnose sepsis. Sensitivity and specificity were calculated using a standard two by two table. Chi square analysis was used for categorical data.

Values are expressed as mean ± standard deviation.

Results 10,201 screens were completed on 1,637 trauma patients admitted to a Level 1 Trauma Center. The incidence of sepsis was 7.3%. The sepsis screening tool

had a sensitivity of 92.5%, specificity of 97.4%, positive predictive value of 73.5% and negative predictive value of 99.4%. There was no difference in the age

(43.3±18.15 vs. 42.7±19.1, p= 0.74) or gender (74.1% male vs. 68.7% male, p=0.22) of patients with sepsis and without sepsis. Patients that developed sepsis had

higher injury severity scores (23.3±12.3 vs.12.7±9.3, p<0.0001), increased hospital length of stay (31.1±26.7 vs. 8.5±8.4, p <0.0001), increased intensive care unit (ICU)

length of stay (16.4±16.3 vs. 1.7±3.9, p<0.0001), and fewer ICU free days (14.7±19.4 vs. 6.9±7.1, p <0.0001). Thirty-day ICU mortality decreased from 13% to 8%

(p=0.08) after implementing the sepsis screening tool.

Conclusions Sepsis in trauma patients has a significant impact on patient outcomes. Our sepsis screening tool accurately identifies sepsis in trauma patients with a high

sensitivity and specificity. The implementation of routine screening was associated with improved ICU mortality rates.

Simple, Reliable Sepsis Screening Tool Improves Mortality in Trauma PatientsLaura Moore, Rosemary Kozar, Jeff Brekke, Joseph Love, Michelle McNutt, Bryan Cotton, Rondel Albarado, John Holcomb

Crit Care Med. 2014;42(12)

http://www.medscape.com/viewarticle/836238_print

1 of 1 2/6/2015 8:22 PM